Introduction. More than 1 million new cases of rectal cancer (RC) are annually detected worldwide, and together with colon cancer this tumor is the 4th most frequent cause of cancer death.

Objective: To analyze short-term prognosis of RC incidence for certain population subgroups in the Arkhangelsk region, Russia.

Material and methods. The data on all primary RC cases in the Arkhangelsk region in the time period from 2000 to 2015 were selected. Crude (whole population) and age-standardized incidence rates were calculated depending on gender and place of residence (urban or rural). The ARIMA model (autoregressive integrated moving average) was chosen to analyze the variations of the time series and to estimate prognosis. To transform the series to a stationary form and to reduce dispersion, the first or second differences of their values and the natural logarithms were taken. The incidence values for the period 2016–2018 were predicted on stationary series of RC incidence from 2000 to 2015.

Results. Crude and age-standardized RC incidence rates in Arkhangelsk region increased from 14.4 and 11.4 in 2000 to 23.5 and 15.1 per 100,000 in 2015. Age-standardized RC incidence rates for males, females, urban and rural populations increased from 14.8, 10.1, 9.3 and 15.1 to 20.3, 12.6, 12.3 and 20.4 per 100, 000, respectively. Actual values of incidence rates among all population, male/female and rural/urban population in 2015 were within the confidence interval of the prognosis. The constructed prognosis model assumes an increase in the RC incidence among all population groups, which may cause the detection of 279 new cases by 2018; i.e. 16 cases (6%) more than in 2015.

The purpose of study was an assessment of the incidence and mortality rates for kidney, prostate and bladder cancer in the Amur region of the Far Eastern Federal District.

Material and methods. Incidence and mortality rates for kidney, prostate and bladder cancer, cancer registry data, and ten-year follow-up data were used.

Results. During the period 2007–16, the incidence and mortality rates for kidney, prostate and bladder cancer steadily increased in the Amur region. The trends in the morbidity and mortality were determined for all groups of the study population. The quality of the service activity indicated by the index of reliability of patients’ registry was estimated. As a prognostic test, the values of «disease severity» («disease burden») were studied. Based on these values, the assumptions about the most favorable prognosis and quality of life in patients with kidney cancer relative to patients with prostate and bladder cancers were made.

Introduction. Primary transrectal multifocal prostate biopsy is the standard method for prostate cancer (PCa) verification, with the detection rate of 53 %. The purpose of the study was to improve findings of transrectal ultrasound-guided prostate biopsy (TRUS-biopsy) by its optimization due to perfusion computed tomography (PCT).

Material and methods. The study included 97 patients with indications for TRUS-biopsy. All patients underwent PCT of the prostate before biopsy. Prostate cancer was detected by PCT in 43 patients. These patients underwent standard primary transrectal multifocal prostate biopsy plus additional targeted punctures from areas of increased blood flow. The results of standard and targeted punctures were compared. The McNemar criterion was used to assess the statistical significance of the differences.

Results. There were no statistically significant differences in the incidence of PCa detection between standard and targeted punctures (p>0.05). However, statistically significant differences in the detection of PCa of different differentiation grades were found between standard and targeted punctures for PCa with a Gleason score of 8 (4 + 4). The detection rate of PCa with the Gleason score of 8 (4 + 4) was 5 % for standard punctures and 14 % for targeted punctures (p˂0.05). No one statistical method has been used to assess sensitivity and specificity, due to the absence of a «gold» standard (histological examination of the total amount of prostate tissue after radical prostatectomy).

Conclusion. The use of primary prostate biopsy optimized with PCT findings does not allow increase in the detection rate of PCa. However, this method improves the verification of PCa with a Gleason score of 8 (4 + 4) that can influence the risk stratification and selection of further therapeutic strategy.

The treatment of patients with glioblastoma continues to be one of the greatest challenges. Glioblastoma is the most aggressive malignant primary brain tumor and is the most lethal among all cancers. Despite advances in the standard treatment, the prognosis for patients with glioblastoma remains poor, therefore, the development of novel treatment strategies is required.

Material and methods. Our study included 30 patients with newly diagnosed glioblastoma, who underwent concurrent chemoradiotherapy and local hyperthermia.

Results. The median disease-free and overall survival rates were 9.6 months and 23 months, respectively. The analysis of clinical, molecular-genetic and prognostic factors related to treatment modality showed statistically significant differences in survival between patient groups representing different times for starting adjuvant therapy after surgery. The median disease-free survival was significantly higher in patients who received chemoradiotherapy with local hyperthermia within 6 weeks after surgery than in patients who started adjuvant treatment earlier. The overall survival rate was statistically higher in patients receiving a special treatment for tumor recurrence compared to that in patients receiving symptomatic therapy. The evaluation of molecular-genetic prognostic factors showed no statistically significant differences in survival among patients with methylated and nonmethylated MGMT promoter. The presence of IDH1 mutations was identified in only one case. Evaluation of prognostic factors does not allow identification of clinical and molecular biological factors that group patients with hypersensitivity to the proposed treatment regimen. However, high rates of overall and disease-free survival, even in patients with non-methylated MGMT, allow us to recommend this treatment modality for patients with newly diagnosed glioblastoma.

The purpose of the study was to evaluate the efficacy and safety of hypofractionated postoperative radiation therapy (2.7 Gy per fraction in 15 fractions to a total dose of 40.5 Gy) in comparison with the standard fractionation regimen.

Material and methods. The study included 321 patients diagnosed with stage I–IIIA breast cancer treated in the A. Tsyb Medical Radiological Research Center from 2013 to 2017. The patients were divided into two groups. Group I patients received hypofractionated postoperative radiotherapy at a total dose of 40.5 Gy in 15 fractions with Gy 2.7 Gy/fraction (n=223). Group II patients received conventional radiotherapy at a total dose of 50 Gy in 25 fractions with 2 Gy/fraction (n=98). Both groups were comparable in terms of the stage of the disease and molecular subtype of the tumor. The statistical analysis of the main characteristics of the studied regimens was carried out.

Results. The analysis revealed no significant differences in the overall survival (OS) and disease-free survival (DFS) between two groups. The frequency of acute radiation-induced complications (grade 1 and 2) in Groups I and II were 79 % and 84 %, respectively. Late radiation-induced side effects were observed less frequently in patients treated with hypofractionated postoperative radiotherapy than in the control group patients (23 % versus 43 %, p<0.01). Severe post-radiation damage to normal tissues was not found. The extent of surgery did not affect the long-term treatment outcomes.

Conclusion. Comparison of hypofractionated radiotherapy with conventional radiotherapy in breast cancer patients demonstrated the superiority of hypofractionated radiotherapy regimen in terms of late toxicity and economic profitability. Further studies of accelerated fractionated postoperative radiotherapy are required to improve the treatment outcomes in breast cancer patients.

Visualization of sentinel lymph nodes (SLN) is now widely accepted for lymph node (LN) detection using a radioactive lymphotropic trace. Preoperative lymphoscintigraphy with intraoperative lymphatic mapping under gamma detecting probe guidance proved to be an easy and reliable method for SLN detection.

Material and methods. In this article we present our experience in using laparoscopic gamma-probe for intraoperative visualization of sentinel lymph nodes in gynecological cancer.

Results. Intraoperative visualization of sentinel lymph nodes in young cervical cancer patients and in patients with stage I endometrial cancer allowed us to perform radical surgery with personalization of the extent of lymph node dissection, especially for patients with low and intermediate risks of lymphogenic metastasis.

Activating mutations of EGFR are associated with sensitivity of non-small cell lung cancer (NSCLC ) to tyrosine kinase inhibitors (TKI). Liquid biopsy using circulating cell-free tumor DNA (cfDNA) is proposed in cases when formalin fixed paraffin embedded (FFPE) tumor tissue is not available and for monitoring of EGFR status. In the study we evaluated new qPC R assay for EGFR mutations in plasma cfDNA. Sensitivity of the assay was 1 % of the mutant allele for L858R, L861Q, S768I mutations and deletions in exon 19, and 5 % of the mutant allele for G719X or T790M mutations Before surgery, mutation was detected in plasma of 4 out of 7 patients (57 %) with mutant EGFR in FFPE tumor tissue. Mutations found in cfDNA completely matched those found in tumor tissue in 2 cases. In one case with G719X and S768I mutations in FFPE tissue, only S768I was found in cfDNA. In another case, T790M was detected in plasma in addition to L858R that was present in tumor tissue. No EGFR mutations were detected in plasma DNA from 12 healthy volunteers and 13 cases of NSCLC with wt EGFR suggesting 100 % specificity of the assay. Liquid biopsy detected EGFR mutations in cfDNA in 8 of 16 cases of NSCLC with mutant EGFR being under therapy with TKI. Among them, 7 cases had mutations in liquid biopsy that matched those in tumor tissue and another case had T790M in addition to L858R. In 3 cases increased mutant allele frequency was detected 212 months before clinical progression.

Carcinoembryonic antigen (CEA) is widely used to evaluate the effectiveness of treatment in patients with rectal cancer.

The aim of the study was to investigate whether the CEA levels measured before and after neoadjuvant chemoradiotherapy (nCRT) can be used to predict pathological complete response (pCR) in patients with locally advanced rectal cancer.

Material and methods. 179 patients with locally advanced rectal cancer were treated with nCRT followed by surgical treatment. The serum CEA level was measured before and 610 weeks after the completion of nCRT. Preand post nCRT CEA levels were compared with pCR. The factors associated with pCR were studied.

Results. pCR after nCRT was achieved in 12 % (22/179) patients. The incidence of pCR was higher in patients with normal (<5 ng/mL) pre-treatment CEA level (20 % vs 8 %, p=0.019). In patients with the elevated pre-treatment CEA level (> 5 ng/mL), there were no significant differences in the incidence of pCR between cases with normalization and without normalization of CEA level after treatment (p=0.08). The maximum likelihood of pCR determined by the ROC curve was <2.8 ng/mL with pre-treatment CEA (31 %) and <1.8 ng/mL with post-treatment CEA (23 %). Well differentiated tumors (G1) had higher likelihood of pCR (46%) in patients with low pre-treatment CEA (<2.8 ng/mL).

Conclusion. Low CEA before and after nCRT is a predictor of pCR. Well differentiated tumors increase the probability of pCR after nCRT.

In the post-operative period of maxillofacial oncological operations, tracheostomy is the most commonly used method for securing the airway. These untoward complications made practitioners choose alternative modalities like submental intubation, but literature support on alternatives to tracheostomy for oral oncologic cases is limited. The aim of this observational study is to ascertain whether the use of overnight intubation is a safer and cost-effective practice and if it can be considered an alternative to tracheostomy.

Material and methods. 30 patients, 23 males and 7 females in the age group of 34–80 years who underwent treatment for head and neck cancer with major intraoral resection and a unilateral or bilateral neck dissection were included in the study. The following variables were recorded: age, sex, site of tumour, type of neck dissection, use of mandibulotomy/ mandibulectomy, type of reconstruction, duration of stay in ICU, mean hospital stay and Mallampati classification. Postoperative complications, associated with the airway, if any, were recorded simultaneously.

Results. None of the 30 patients required re-intubation nor did they develop any respiratory distress post extubation.

In the Russian Federation, the incidence of cancer diagnosed at an advanced stage still remains high. A majority of patients (75 %) present with an advanced disease. The goal of palliative care is achievement of the best quality of life and relief of suffering of cancer patients. However, today there is no single model of palliative care.

The aim of the study was to analyze the activities of the Department of Palliative Care of Almetyevsky Branch of the Republican Clinical Oncology Center of the Republic of Tatarstan.

Material and methods. The Palliative Service of the Republic of Tatarstan is unites several institutions, including the Almetyevsky branch of the Republican Clinical Oncological Dispensary, which was organized in 2015. Based on the population of Almetyevsky region, there are two medical outreach teams.

Results. Between 2016 and 2017, 1 025 patients received palliative care at home, and 6 625 visits were made. Pain syndrome was the most common reason for admission (more than 80 %) followed by depression (more than 80 %), disability disorders (more than 40 %), insomnia (25 %), dyspnea (22 %), and impaired consciousness (5 %). As a result of the creation of this service, a decrease in the number of ambulance visits to patients was recorded: from 92 to 12 % for the reason of severe intolerable pain, from 75 to 6.6 % due to moderate pain and from 6.7 to 0, 3 % due to mild pain. The incidence of unjustified hospital stay decreased by 28 %.

Conclusion. Organization of the team of professionals invoplved in providing high-quality cancer care in Almetyevsk helped to improve the quality of palliative care for incurable cancer patients.

Smoking, overweight, obesity, hypertension, occupational exposures to pesticides, specifically to trichloroethylene are considered causal risk factors for sporadic i.e. non-hereditary renal cell cancer (RCC). Some of these factors not only increase the risk of RCC but also affect the survival of patients. For example, in patients with RCC who continue smoking, the risk of dying from other causes is twice as high as in patient who quit smoking. The risk of second cancer is 5 times higher in patients who continue smoking 20 or more cigarettes per day than in non-smokers. The low penetrance polymorphism is an important factor in etiology of sporadic RCC, which contrary to high penetrance mutations is a common event. However, the risk associated with this type of inheritance is quite low. The majority of sporadic RCC have polygenic etiology. They develop as a result of combined effect of large number of low penetrance genetic susceptibility genes (genetic polymorphism). Environmental factors play a decisive role in causation of sporadic RCC. The interplay of exposures to environmental risk factors and genetic susceptibility of exposed individuals is believed to influence the risk of developing sporadic RCC. The studies in molecular epidemiology based on candidate gene approach have shown that polymorphisms of certain genes, for example glutathione-S-transferase family genes, are associated with RCC. The genome wide association studies identified about twenty loci with single nucleotide polymorphism (SNPs) affecting the risk of RCC. However the risk loci so far identified for RCC account for only about 10 % of the familial risk of RCC. The power of largest studies which include many thousands of observations allow to detect 80 % of the major common loci (with minor allele frequency – MAF>0.2) conferring risk ≥1.2. However, for detecting alleles with smaller effects and/or MAF<0.1, more studies with larger sample size are needed. By implication, variants with such profiles probably represent a much larger class of susceptibility loci for RCC and hence a large number of variants remain to be discovered. Future investigation of the genes targeted by the risk SNPs is likely to yield increased insight into biology of RCC and will lead to new approaches for prevention, early detection and treatment.

Skin and soft tissue infections are one of the most common nosocomial infections, which are caused most often by gram-positive bacteria (staphylococci, streptococci, enterococci) with multiple drug resistance. These infections are among the major nosocomial infections in oncology clinics along with respiratory and urinary tract infections, blood flow infections, febrile neutropenia, and fevers of unknown origin.

The purpose of the study was to compare the clinical activity of two oxazolidinones: linezolid and tedizolide in patients with skin and soft tissue infections.

Material and methods. We analyzed recent publications and data available in websites: rlsnet.ru, eucast.org, and medlux.ru.

Results. Clinical trials showed that both oxazolidinones were comparable in clinical efficacy, microbiological activity, and incidence of side effects in skin and soft tissue infections caused by various resistant gram-positive microorganisms: methicillin-resistant staphylococcus aureus (MRSA) and vancomycin-resistant Streptococcus faecalis (VRE), as well as certain streptococci. The treatment regimen of tedizolide (200 mg once daily for 6 days) was compared with linezolid regimen (600 mg twice daily for 10 days). No comparisons were made with the 6-day linezolid regimen, although the authors concluded that shorter duration of treatment with tadizolide resulted in an equal effect. In addition, the minimum inhibitory concentrations (MICs) obtained by comparing the microbiological activity of these two agents showed the advantage of tedizolide against certain strains. However, the comparison was not made according to the EUCAST standards (Committee on Antimicrobial Susceptibility Testing). Concerning the cost of both drugs, treatment with linezolidom was 2-3 times cheaper than treatment with tidezolid, even with its shorter course.

Over the past few years, significant advances in surgical and anesthetic techniques as well as appropriate selection of patients have led to an improvement in the immediate and long-term treatment outcomes in patients with non-small cell lung cancer with involvement of tracheal bifurcation. In accordance with the current selection criteria, patients with contralateral lymph node metastases (lung root, aortic window, paratracheal area) require chemotherapy or chemoradiotherapy with subsequent estimation of follow-up and treatment strategy. Surgeries with resection of tracheobronchial bifurcation are considered technically complicated, and they should be performed in carefully selected lung cancer patients and only in specialized centers with extensive experience. It allows the incidence of intra-and postoperative complications to be significantly reduced.

The purpose of the study was to review available data on various techniques for radical trachelectomy, inclusion criteria, advantages and disadvantages.

Material and methods. A systematic literature search was conducted in the electronic databases of Medline, Russian Science Citation Index, and Russian State Library in the interval time between 1997 and 2017.

Results. To date, only radical trachelectomy has shown its value regarding both aspects of oncologic and reproductive outcomes in patients with invasive cervical cancer. There are currently 5 approaches to radical trachelectomy: transvaginal approach with laparoscopic pelvic lymphadenectomy, abdominal, laparoscopic, robot-assisted and laparoscopic – vaginal approach. Each technique has its advantages and disadvantages.

Conclusion. Over the last years, radical trachelectomy has been recognized as a valuable fertility-preserving option for women of child-bearing age with invasive cervical cancer. Radical trachelectomy should be performed by highly skilled surgeons in specialized clinics.

Background. Breast cancer is the second most common cancer worldwide. Despite significant advances in breast cancer treatment, more than 50 % of patients develop recurrence following completion of treatment. If there is a suspicion of disease progression, the differential diagnosis of metastatic tumor and non-metastatic lesion using the standard imaging methods can be difficult. A modern approach to the detection and assessment of the extension of recurrent disease is individual evaluation of the biological characteristics of the tumor, including determination of the status of estrogen receptors with the goal of adequate treatment. PET/CT with 18F-fluoroestradiol in patients with hormone-dependent breast cancer can be used to determine the expression of estrogen receptors (RE) in tumor tissue and assess the presence of receptor-positive metastases throughout the body in a single study.

Case description. We report the cases of 55-year-old and 57-year-old women with hormone-dependent breast cancer after standard treatment (surgery, radiation therapy and hormone therapy). During hormone therapy, lung lesions were detected in both patients. To assess the activity of these lesions, 18F-fluoroestradiol PET/CT was used. In the first case, a low uptake of 18F-FDG was observed. In the other case, no18F-FDG uptake was found. Given that both patients had hormone-dependent breast cancer, it was decided to perform PET/CT with 18F-fluoroestradiol (18F-FES) to evaluate the expression of ER. In the first case, the 18F-FES uptake was detected in all lesions that indicated the evidence of metastases. Histological examination confirmed the evidence of metastatic tumor. In the second case, no uptake of 18FFES was detected in the foci and the patient was followed-up for 6 months. Computed tomography showed decrease in the size of lesions.

Conclusion. The use of 18F-FES PET/CT can be an important diagnostic tool for detection of disease progression in patients with hormone-dependent breast cancer. In case of detection of positive foci on 18F-FES PET/CT scans, hormone therapy for breast cancer can be administered without invasive procedures for verifying the diagnosis.

The differential diagnosis of pulmonary diseases is extremely difficult and requires high qualifications of the radiologist and clinician. The differential diagnosis is used to distinguish different lung diseases: nonspecific inflammatory lung diseases (empyema, abscess, pneumonia), tuberculosis, sarcoidosis, benign tumors, lung cancer, lymphogranulomatosis, metastatic changes, and inflammatory changes in lung tissue. We present a clinical case, in which the differential diagnosis between tumor and inflammatory changes in lung tissue allowed the choice of optimal treatment tactics.